New Orleans facility a leader in breast reconstructive surgery

Thandi Fletcher, Postmedia News11.08.2012

Breast reconstruction patient Karen Kozlowski recovers on Jan. 21, 2012, in her room at the Center for Restorative Breast Surgery in New Orleans, where she underwent reconstructive breast surgery two days earlier.Thandi Fletcher
/ Thandi Fletcher

The exterior of St. Charles Hospital and the Center for Restorative Breast Surgery in New Orleans, a private hospital lauded as a centre of excellence in the field of breast reconstruction.Courtesy
/ St. Charles Hospital and the Center for Restorative Breast Surgery

A lavish waiting room at St. Charles Hospital and the Center for Restorative Breast Surgery in New Orleans, a private hospital lauded as a centre of excellence in the field of breast reconstruction.Courtesy
/ St. Charles Hospital and the Center for Restorative Breast Surgery

Staff at St. Charles Hospital and the Center for Restorative Breast Surgery in New Orleans, a private hospital lauded as a centre of excellence in the field of breast reconstruction.Courtesy
/ St. Charles Hospital and the Center for Restorative Breast Surgery

The entrance to the St. Charles Hospital and the Center for Restorative Breast Surgery in New Orleans, a private hospital lauded as a centre of excellence in the field of breast reconstruction.Courtesy
/ St. Charles Hospital and the Center for Restorative Breast Surgery

A patient recovery room at St. Charles Hospital and the Center for Restorative Breast Surgery in New Orleans, a private hospital lauded as a centre of excellence in the field of breast reconstruction.Courtesy
/ St. Charles Hospital and the Center for Restorative Breast Surgery

NEW ORLEANS - Inside a grand building on historic St. Charles Avenue in New Orleans, three top-tier surgeons are perfecting some of the most advanced breast reconstruction procedures in the world.

There is no sign on the grey building’s streetside facade to inform passersby of its inner happenings.

But given the thousands of breast-cancer survivors who have emerged from this building with reconstructed breasts, and a restored sense of femininity and wholeness, advertising hardly seems necessary.

The Center for Restorative Breast Surgery is the only hospital in the world dedicated solely to breast reconstruction. It was founded in 2003 by Dr. Frank DellaCroce and Dr. Scott Sullivan, and they were later joined by Dr. Christopher Trahan.

The facility was launched with a goal of becoming a leader — a centre of excellence — in the field of microsurgical breast reconstruction.

Thousands of surgeries later, with one of the highest success rates in the world, it would be fair to say the team has met, even surpassed, that level of excellence.

In online breast cancer support groups, women from both the United States and Canada rave with near adoration about the centre they’ve fondly dubbed NOLA, short for New Orleans, Louisiana.

One of those women is Karen Kozlowski of Boise, Idaho, who travelled to the centre in January to undergo a mastectomy, followed immediately by reconstruction.

“They’ve had unbelievable results,” Kozlowski said, as sun streamed in through the arched glass roof of the centre’s opulent waiting room. “I’ve met women online who have come here and have nothing but good things to say about their time here. Their outcomes are amazing, absolutely amazing.”

As Kozlowski, 48, sits down to talk to Postmedia News before her surgery, taking in the luxurious decorating throughout the centre, she jokes that she feels as if she “could fall asleep right now.”

As health troubles have plagued Kozlowski, a mother of two young daughters, for the past two years, it’s no surprise she feels like she could take a nap.

In November 2009, Kozlowski found out she had an aggressive form of breast cancer. Her surgeon recommended removing both breasts.

As an operating room nurse, Kozlowski said she knew about reconstruction and wanted to pursue it.

“It’s a psychological thing,” said Kozlowski. “To wake up without any breasts, and you look at the pictures of people who have had a mastectomy, I guess I just didn’t want that to be me.

“Your breasts are a lot of who you are as a woman. It’s a part of your body and you don’t want to lose that part.”

Kozlowski sought immediate reconstruction using tissue expanders (temporary implants that are slowly inflated using saline injections over several months to stretch out her chest muscle and skin). Later on, she would have a second surgery to replace the expanders with permanent silicone implants.

However, before she was set to go under the knife, doctors found another type of cancer elsewhere in her body, which she needed to treat first. Instead of a mastectomy, Kozlowski had a lumpectomy, a less invasive surgery to have a lump of breast tissue surrounding the tumour removed.

With the mastectomy postponed, any thoughts of reconstruction were put on hold.

“I had to kind of wait awhile to see if I would still be around,” she said.

But on this day, as she sits in the centre’s sun-filled atrium awaiting her pre-op consultation for her mastectomy, Kozlowski describes the second cancer as a “blessing in disguise.”

During the wait, she said she came to realize that reconstruction with implants wasn’t the procedure for her. Instead, she wanted to pursue autologous breast reconstruction, a much longer and more complex surgery using tissue from another part of her body—her hips—to shape into new breasts.

Autologous breast reconstruction offers a woman a more natural alternative to implant-based reconstruction as it uses her own skin and fat. It is also a permanent procedure, unlike implants, which often need to be replaced after 10 years.

“When I was first diagnosed I was really afraid of (autologous reconstruction),” she said. “This is a very specialized procedure, and I just didn’t think I could handle a big surgery and a big recovery. I just wanted to get back to work, so in essence I was settling for the tissue expanders and the implants . . . .

“It was a blessing in disguise because now I’m going to be able to do what I really, I think in my heart, knew I needed to do.”

Although she no longer has active breast cancer, Kozlowski said the chance of recurrence was high and she opted to remove her breasts as a preventive measure, along with reconstruction.

But there were no plastic surgeons who performed autologous breast reconstruction at the hospital where she worked. Kozlowski began to look elsewhere and found the Center for Restorative Breast Surgery.

At the centre, the surgeons removed both of her breasts and, at the same time, rebuilt them through a simultaneous bilateral GAP flap. The GAP flap uses the tissue from both sides of a patient’s buttocks and hips.

The centre was the first in the world to develop the procedure to reconstruct both breasts in one operation. Typically, GAP flaps are performed one breast at a time, requiring two separate operations usually several weeks apart.

However, at the Center for Restorative Breast Surgery, the surgeons operate together as a team to cut down on the amount of time the patient spends on the OR table.

After seeing the results for many women she met through an online message board, Kozlowski said she began to feel a sense of hope for the first time since her diagnosis.

“I got excited because I thought: ‘I’m going to lose my breasts, but I’m going to end up with something just as nice, if not nicer,’” she said with a smile.

Kozlowski’s excitement, along with the ocean sounds playing in the background as she filled out her hospital paperwork, surely dampened any lingering anxiety she had about the massive surgery.

“It’s hushed, it’s quiet. It’s just beautiful. It’s a place you’d actually want to sit and have a cocktail in with some friends,” she said, with a laugh.

That soothing, restful feeling was the effect Dr. Scott Sullivan says they intended when they set out to create their dream hospital.

“When you walk into the place, it looks like a hotel,” he explained in a soft Southern drawl.

“We tried to create a setting of comfort, of security, of hope and that certainly helps as you make someone feel that they’re being cared for, that they’re your No. 1 patient.”

The idea for creating a hotel-like experience came about when Sullivan and his partners realized that medical offices in posh places like Beverly Hills were lush and extravagant.

But for breast cancer patients, Sullivan said the waiting rooms in some hospitals were more like bus stations than luxury hotels.

“If anyone needed to be pampered and treated well, it’s these poor women going through this difficult time,” Sullivan said. “We were very unhappy with where certain hospitals were going, that the patient was becoming more and more neglected . . . . There was a feeling of abandonment, and we just didn’t want that to happen.”

A calming, reassuring environment can help patients recover faster, said Sullivan.

The lavish atmosphere of the waiting room carries on to the 12 post-surgery recovery rooms in the adjacent St. Charles Surgical Hospital. Patients recover in spacious private rooms with their own personal nurse.

“The nurse to patient ratio is, at worst, one nurse to two patients,” he said. “It’s sort of like an ICU-type setting. They’re able to get the care and attention that they need to facilitate their recovery.”

Each room also has a large flat screen television, private bathroom, and an extra bed available for a friend or family member.

RECONSTRUCTION OFFERS HOPE DURING DIFFICULT TIMES

For many women at the centre, Sullivan said the option of reconstruction is often the sole bright side to a devastating diagnosis.

Up to that point, they’ve gone through the “whirlwind” of fearing for their mortality, worrying about their children and their spouse, thinking about all the things they’ve yet to achieve in their lives, and often dealing with fears they will lose their hair during chemotherapy, he said.

For some of the women, they only choose reconstruction after living for years with a mastectomy. Often, it’s because of feelings that “it’s a selfish thing to do,” said Sullivan.

“It’s because of the guilt,” he said. “The guilt of, ‘I can’t put my family through this, I need to put them first.’ . . . That’s the last thing they should be feeling.”

Since opening a 18,000-square-metre hospital adjacent to the centre in 2006, the doctors have been able to see a greater volume of patients, about 550 a year. Sullivan said he alone has performed more than 4,000 breast reconstructions.

Having unlimited operating room access has allowed them to achieve an incredibly high success rate, he said. For surgery that uses tissue from the patient’s abdomen, their failure rate is only about “two-tenths of a per cent.” Procedures using the hip or the buttock region have a failure rate of less than one per cent. Sullivan said the national average is about one to five per cent.

“We do more of these perforator flaps than anywhere else in the world,” he said. “The sheer volume and the repetition allow us to refine our techniques even more and create more cutting-edge advancements.”

Many women travel to the centre for corrective surgery after having poor quality reconstruction elsewhere, said Sullivan. In some cases, their chests look “almost grotesque,” he said.

Yet when they raise their concerns with their surgeon, Sullivan said, they are sometimes told the outcome is the best they should expect.

“They tell them, ‘Look, honey, you need to be glad you’re alive,’” he said. “If that was my wife and some doctor told me that, I’d punch him out. I’d be so furious. I can’t believe how insensitive that is.”

At the centre, Sullivan said the goal is to preserve their patients’ self-esteem through restoring their breasts to be as good as or, in some cases, even better than their original breasts.

“If we can help them realize that, physically, they will be able to get through this, and get through it well . . . you start to help with those psychosocial issues that occur for these women that plays a big part in their rehabilitation,” said Sullivan.

While most patients at the centre are from the U.S., many others travel there from outside of the country, including several each year from the United Kingdom and Canada.

One of those patients is breast reconstruction patient Lorna Frost of Britain, who was diagnosed with breast cancer and underwent a mastectomy in 2006.

After a “botched” reconstructive surgery at home, Frost started searching online to understand how her surgery could have gone so wrong. She came across the website for the Center for Restorative Breast Surgery.

“Initially, I thought their before and after photos were fixed,” said Frost, who lives in the seaside town of Weston-super-Mare.

In the U.K., Frost had undergone a DIEP flap in February 2007, in which some her abdominal fat and skin was used to rebuild the breast after she had a mastectomy. The result was far from what she expected.

“It was horrific,” she said. “It looked like a ring donut folded over. There was a very deep crease going across the entire breast.”

The failed surgery was difficult on her emotional well-being, she said. Soon after the operation, her longtime partner also died unexpectedly.

“I viewed the operation as the conclusion of everything, but the reality turned out that it was just a start of a bit of a nightmare for me,” she said.

Although she sought second opinions from two local plastic surgeons, Frost said they were “arrogant” in how they treated her.

“He told me that he was very happy with the results and that I should be grateful,” she said. “I really didn’t trust the plastic surgeons here.”

Frost decided to go to New Orleans, where Dr. DellaCroce “fixed the mess” from her first procedure. DellaCroce also improved the appearance of the scar tissue on her abdominal area from the original reconstruction, she said.

“The man is an absolute saint,” said Frost.

ALTERNATIVE TO A LONG, LONG WAIT IN CANADA

From Canada, Laurie Kelly of Victoria travelled to the centre and paid more than $50,000 to have breast reconstruction in late 2010.

Kelly sought to have autologous breast reconstruction using skin and fat from her buttock to rebuild her breast. In Canada, she said, she could only find one surgeon who could perform that type of surgery. She also she faced at least a two- to three-year wait just for a consultation.

Still, the cost of her surgery abroad was not reimbursed by the Medical Services Plan in British Columbia, she said.

As her surgery could have been performed in Canada, albeit with a significant wait time, Stephen May, a spokesman for the B.C. Ministry of Health, said breast reconstruction in the U.S. would not be covered.

While there are “some rare exceptions,” the coverage must be pre-approved by the medical services commission and could only be granted if “all avenues of treatment within the Canadian health-care system have been exhausted,” he wrote.

Although she and her husband still have a hefty debt to deal with, Kelly said she is thrilled with the results and has no regrets.

“We obviously need this type of facility in Canada,” said Kelly. “I don’t know how it would be run, but we need the microsurgeons, the experience, and the compensation.”

Sullivan said he has heard many tales of despair from Canadian women facing a multi-year wait for reconstruction.

The long delay can be incredibly discouraging, he said.

“It requires on some part a short term of their lives to be living without breasts, which is somewhat demoralizing and is always, unfortunately, a constant reminder of their battle with breast cancer,” he explained.

At the centre, patients with active cancer are operated on within two weeks, usually sooner, said Sullivan.

For women seeking reconstruction after they have already had a mastectomy, they have the luxury of selecting a surgery date that best suits them.

Wait times are virtually unheard of at the centre, he said.

Two days after a successful six-hour surgery, a groggy but smiling Kozlowski is in her room recovering. Looking down at her bandaged chest, she smiles.

“I have something here, which is kind of amazing to look down and see that,” she said.

Although she is experiencing some pain, Kozlowski said she “feels good.”

“It’s almost as if, you know, the cancer takes so much away from you. And it’s almost like it didn’t take it away from me because I was able to have a reconstruction and wake up with something there.

“I think it was a great decision to come down here,” she said. “They’re the best at what they do.”

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